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Review of cardiovascular risk with tamoxifen vs aromatase inhibitors

Takeaway

  • Existing evidence suggests an increased risk of venous thromboembolism (VTE) in tamoxifen users vs non-users and aromatase inhibitor (AI) users among women with a history of early breast cancer.
  • Tamoxifen may have a protective association with vascular cardiovascular diseases (CVDs).

Why this matters

  • Previous meta-analyses have reported the effect of adjuvant endocrine therapies on the risk of composite CVD outcomes.
  • This review reports the effect on clinically specific CVDs.
  • It establishes the need for clinical vigilance and possible preventive measures when prescribing endocrine therapies to women at risk of VTE.

Key findings

  • Consistent evidence of increased VTE risk in tamoxifen users vs non-users.
  • Decreased VTE risk with AIs compared directly with tamoxifen.
  • Direct effect of AIs on VTE was less clear.
  • Higher risk of myocardial infarction (MI) and angina with AIs vs tamoxifen.
  • Inconsistent results for associations with AIs and stroke.
  • Risk of peripheral vascular disease with AIs vs tamoxifen was inconclusive.
  • Increased risk of heart failure with AIs vs tamoxifen in a single RCT was not replicated in an observational cohort study.
  • Tamoxifen was associated with a decreased risk of heart failure compared to non-users, but with wide confidence intervals.
  • Findings on risk of arrhythmia in tamoxifen users vs non-users were inconclusive.

Study design

  • Systematic review and meta-analysis of 15 randomised controlled trials (RCTs) and 11 observational studies published on Medline and Embase up to June 2018.
  • Funding: Wellcome Trust and Royal Society.

Limitations

  • High risk of bias.
  • Potential for missed studies.

References


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